2024年12月 保髋进展 JCR Q2 区

Aneurysmal bone cysts (ABCs) in the periacetabular region can be challenging to treat because they create unique problems, given their proximity to articular cartilage and a significant weight bearing surface. This case series details the assessment and treatment of four periacetabular ABCs with a review of pertinent current literature. Treatment approaches used include curettage with 6% phenol chemical adjuvant, type III hemipelvectomy, serial image-guided sclerotherapy injections, and in one case, an exostotic lesion was treated with hip arthroscopy.

In evaluations of a cam deformity on femoroacetabular impingement, the head-neck junction (HNJ) must be accurately assessed. We conducted this study to determine the ability of plain radiography to visualize the end-to-end bone surface of the HNJ. We used six human bone models. Ten examiners evaluated the degree to which attached stainless wire marker at the 1:00, 1:30, and 2:00 radial plane defined in reconstructed computed tomography can be accurately detected on the bone surface on plain radiographies. We employed 13 plain radiographies: the cross-table lateral view, frog-leg lateral view, Espié frog-leg lateral view, false-profile view, modified false-profile view, 30° Dunn view (DV), 45° DV, 60° DV, 90° DV, 30° modified Dunn view (MDV), 45° MDV, 60° MDV, and 90° MDV. Examiners scored the degree to which the radiographic images accurately detected the stainless wire marker on the bone surface of the HNJ on a scale of 1 point (0% match) to 5 points (almost 100% match). The highest score for the 1:00 plane was 4.98 points on the 45° DV. Similarly, the highest scores of the 1:30 and 2:00 planes were 4.98 points for the 45° MDV and 4.68 points for the 90° MDV, respectively. On these bone model studies, the most suitable plain radiography for describing the HNJ at the 1:00, 1:30, and 2:00 planes were both the 45° DV, the 45° MDV, and the 90° MDV, respectively.

The aim of this study was to evaluate the bilateral changes in hip muscle strength after a 6-month rehabilitation period for patients undergoing surgical hip dislocation (SHD) to treat femoroacetabular impingement syndrome (FAIS). We conducted a retrospective analysis on a cohort of 22 patients (mean ± SD age: 26 ± 7, 68% male) who underwent SHD for FAIS between March 2020 and January 2023 at La Tour Hospital. Bilateral isometric strength of eight hip muscle groups (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal, and external rotators) was assessed using a handheld dynamometer before surgery, and at 3 and 6 months postoperatively. After 6 months of rehabilitation, only the external rotators were weaker compared to preoperative levels (-13% ± 23%,

Deep learning is revolutionizing medical imaging analysis by enabling the classification of various pathoanatomical conditions at scale. Unfortunately, there have been a limited number of accurate and efficient machine learning (ML) algorithms that have been developed for the diagnostic workup of morphological hip pathologies, including developmental dysplasia of the hip and femoroacetabular impingement. The current study reports on the performance of a novel ML model with YOLOv5 and ConvNeXt-Tiny architecture in predicting the morphological features of these conditions, including cam deformity, ischial spine sign, dysplastic appearance, and other abnormalities. The model achieved 78.0% accuracy for detecting cam deformity, 87.2% for ischial spine sign, 76.6% for dysplasia, and 71.6% for all abnormalities combined. The model achieved an Area under the Receiver Operating Curve of 0.89 for ischial spine sign, 0.80 for cam deformity, 0.80 for dysplasia, and 0.81 for all abnormalities combined. Inter-rater agreement among surgeons, assessed using Gwet's AC1, was substantial for dysplasia (0.83) and all abnormalities (0.88), and moderate for ischial spine sign (0.75) and cam deformity (0.61).

This study compared outcomes of periacetabular osteotomy (PAO) with and without femoral osteochondroplasty (OCP) in treating symptomatic acetabular dysplasia through propensity score matching. Data from a prospective multicenter cohort of patients undergoing PAO from 2007 to 2014 were analyzed. Inclusion criteria were a lateral center edge angle <25°. The exclusion criteria were history of previous procedure and age >45 years. A 2- to 5-year follow-up interval was utilized; patients outside this follow-up window were excluded. Propensity matching variables included sex, baseline hip internal rotation at 90° flexion, preoperative alpha angle, lateral center edge angle, modified Harris Hip score (mHHS), and arthroscopy at the time of surgery. Propensity scores were calculated using logistic regression with treatment as the dependent variable. Clinical failure was defined as failure to meet the minimal clinically important difference and patient acceptable symptom state for mHHS or a need for reoperation. There were 219 patients that met the inclusion criteria. Of these, 116 patients were matched, representing 58 pairs (PAO/OCP = 58; PAO without OCP = 58). Preoperative functional scores were similar between groups. At mean 4.1 years follow-up, there were no significant differences in the rates of clinical failure or reoperation between the two groups [PAO/OCP = 13 (22%), PAO without OCP = 8 (14%);

Preoperative radiographic measurements may help predict which patients with hip labral tears ultimately undergo repair versus primary reconstruction. This study investigated if radiographic parameters: (i) preoperatively predict labral repair versus reconstruction and (ii) correlate with T2 magnetic resonance imaging (MRI) mapping values of the labrum. This retrospective comparative study included patients aged 14-50 years who underwent labral repair or reconstruction at a single institution over a 2-year period. Patients with prior open or arthroscopic hip surgery or who had inadequate preoperative computed tomography (CT) and MRI imaging were excluded. Labral size was measured at multiple positions on preoperative MRI images. A blinded reviewer used three-dimensional CT analysis to record lateral center edge angle (LCEA), acetabular version, Tonnis angle, acetabular coverage, alpha angle, femoral torsion, and neck-shaft angle (FNSA). T2 MRI mapping values of the labrum were obtained via sequencing analyses on each patient's optimal sagittal cut. Univariate mixed linear models were used to identify associations between each radiographic measurement and decision to repair or reconstruct the labrum. Fifty-two operations were included. Labral size had no predictive effect on undergoing labral reconstruction versus repair. Likelihood for undergoing labral reconstruction was associated with LCEA (

Overnight admission is a rare but major complication after hip arthroscopy (HA), and the paucity of data surrounding its causes limits patient education and quality of care. The purpose of this study was to identify risk factors for an unanticipated overnight admission after HA and assess for associated complications. This analysis queried the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes to identify hip arthroscopies from 2005 to 2017. Patient demographics, perioperative variables, and comorbidities were compared between ambulatory and nonambulatory patients [length of stay (LOS) ≥ 1] using bivariate analysis. Multivariate stepwise logistic regression then identified independent risk factors of adverse outcomes. Linear regression analyzed correlation of LOS with age, operative time, modified fragility index (mFI-5), and year of operation. A total of 2420 cases were included in this study with 400 (16.5%) overnight admissions. The mean subject age was 40 ± 13.9 years old (58.1% female). Admitted patients generally had higher American Society of Anesthesiologists (ASA) scores and a higher mFI-5 index. Multivariate logistic regression showed that mFI-5 > 0, bleeding disorders, operative time >1.5 h, and nongeneral anesthesia were independent risk factors for prolonged hospital stay. Patients aged 31-40 years had decreased risk of LOS ≥1. Nonambulatory surgery was associated with significantly increased risk for any complication, readmission, wound complication, and venous thromboembolism. This analysis demonstrates that operations >1.5 h and increased medical comorbidities predispose patients to greater risk of being admitted to the hospital after HA. Surgeons should consider these data to optimize controllable factors and patient selection to reduce the risk of postoperative admission.

Periacetabular osteotomy (PAO) is a surgical treatment of developmental dysplasia of the hip (DDH). This systematic review investigates the impact PAO has on sexual function and pregnancy through changes in patient-reported outcomes. A literature search of Medline, PubMed, EMBASE, and the Cochrane Library from 1996 to November 2023 was performed. Search terms included: 'periacetabular osteotomy', 'pelvic osteotomy', 'outcomes', 'sexual function', 'pregnancy', and 'childbirth'. Assessment of methodological quality was performed using the methodological index for nonrandomized studies (MINORS) criteria and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. The search returned 560 papers, with 5 meeting the inclusion criteria. Sexual function improved over both short- and longer-term follow-up periods. 48.2% of patients had improved sexual function following PAO. Female patients reported greater improvement than males, who had a higher baseline score. No complications were documented in pregnancy or delivery compared to patients who had not had a PAO. Increased rates of caesarean sections (CSs) were seen in all studies (37.4%) compared to the European average. All five papers were calculated to be of low quality according to the MINORS criteria and low certainty according to the GRADE level of evidence. Patients receiving a PAO due to symptomatic DDH had improved sexual dysfunction due to a reduction in hip pain, but almost half of these patients may not appreciate any benefit. There is an increased likelihood of CS in patients post-PAO, with no reliable evidence for its necessity. Limitations of this review included poor quality and availability of evidence, as all studies were retrospective cohort studies. Further larger powered studies are required to assess the full impact of PAO on both sexual function and pregnancy.

Present recommendations in the literature advocate for a return to sport (RTS) between 5- and 10 months following hip arthroscopy for femoroacetabular impingement (FAI). We have adopted the International Society of Hip Preservation protocol with modifications for the rehabilitation of our patients. The aim of the present study was to examine the time to RTS with this rehabilitation approach after hip arthroscopy for FAI. It was hypothesized that most athletes will RTS by 5 months post-surgery without any adverse effects. Patients undergoing hip arthroscopy for FAI were prospectively followed with preoperative and postoperative Patient Reported Outcome Measures including: Modified Harris Hip Score (mHHS) and Copenhagen Hip and Groin Outcome Score (HAGOS). Preinjury sports and competition level, postoperative RTS rate, time, and level, complications, and revision surgeries were recorded. A total of 56 patients were identified for inclusion (36.6 ± 14.1 years old at date of surgery, 34 females and 22 males). There were 35 recreational athletes and 21 competitive-level athletes (10 in high-demand sports and 11 in moderate-demand sports). In all, 44 patients (79%) returned to sport at 5.3 ± 3.5 months postoperatively. Of the 12 patients who did not RTS, 5 (42%) did not return for reasons other than their hip. Neither HAGOS (

Hip arthroscopy (HA) and periacetabular osteotomy (PAO) are common hip preservation procedures pursued in borderline hip dysplasia (BHD), yet there is no consensus on the preferred treatment. This systematic review aims to synthesize the present literature on HA and PAO for the management of BHD. A review of multiple electronic databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies that reported outcomes of patients with BHD treated by PAO or HA with capsular closure were included. PROs, complications, and rates of subsequent surgery were evaluated. A total of 14 studies met criteria for inclusion. Eight reported outcomes following PAO and seven reported outcomes following HA. One study reported outcomes of both procedures. Both PAO and HA studies demonstrated significant improvement in PROs. Complication rates in PAO patients ranged from 0% to 7.8% compared to 0% in HA patients. Total hip arthroplasty (THO) conversion rates in PAO patients ranged from 0% to 10.5% compared to 0% to 23.7% in HA patients. Hardware removal was performed in 25-51% of PAO patients. PAO conversion following failed HA occurred in 0-6.1% of patients. Rates of other reoperation (excluding hardware removal) in PAO patients ranged from 0% to 22.2% compared to 0% to 7.9% in HA patients. Based on the current evidence, both PAO and HA demonstrate significant improvement in PROs with a low conversion rate to THA, yet additional long-term follow-up studies are required.

Recurrent groin pain following periacetabular osteotomy (PAO) is a challenging problem. The purpose of our study was to evaluate the position and dynamics of the psoas tendon as a potential cause for recurrent groin pain following PAO. A total of 386 PAO procedures, performed between January 2013 and January 2020, were identified from a single surgeon series. Thirteen patients (18 hips) had a psoas tendinopathy, as confirmed with relief of symptoms following a diagnostic injection into the psoas tendon. All patients underwent computed tomography (CT) scans pre- and post-operatively. The data from CT scan was used to manually segment bony structures and create 3D models using Mimics software (Materialise NV). A validated discrete element analysis model using rigid body springs was used to predict psoas tendon movement during hip circumduction and walking. The distance of the iliopsoas tendon to any bony abnormality was calculated. All computational analyses were performed using MATLAB software. Thirteen hips (13/18) showed bony malformations (spurs, hypertrophic callus or delayed union and malunion) secondary to callus at the superior pubic ramus. The mean minimal distance of the iliopsoas tendon to osteotomy site was found to be 13.73 mm (

Femoroacetabular impingement syndrome (FAIS) is a common condition of the hip that can cause significant damage to the joint, leading to degeneration and osteoarthritis. FAIS constitutes an abnormal and dynamic contact between the femoral head-neck junction and the acetabular rim, resulting from altered bone morphology at one or both sites. Repetitive trauma at the site of impingement generates progressive damage to the acetabular labrum, chondrolabral junction, and articular cartilage. Proper diagnosis based on patient symptoms, specific clinical signs, and imaging findings will guide treatment and ultimately allow preservation of the native hip joint. Common symptoms in patients with FAIS include pain, clicking, catching, buckling, stiffness, giving way, and a limited range of motion of the hip. Specific clinical maneuvers can aid diagnosis, such as flexion adduction internal rotation and flexion abduction external rotation tests. Imaging diagnosis includes orthogonal hip and pelvis X-ray views, as well as magnetic resonance imaging/magnetic resonance arthrogram imaging. Initial treatment of FAIS can be conservative and include physical therapy, intra-articular injections, and activity modification. Currently, the preferred surgical management consists of hip arthroscopy, which aims to correct bony abnormalities, repair or reconstruct labral lesions and address other intra-articular and extra-articular derangements as needed.

Periacetabular osteotomy (PAO) is a procedure used to treat patients with hip dysplasia. Current literature reports symptomatic hardware removal (HWR) rates of 13.6% following PAO. No reports have examined the incidence of or factors relating to screw breakage during HWR. This study reports the incidence of screw breakage in patients undergoing HWR following PAO and examines the associated clinical and surgical factors. Patients who underwent PAO by a single surgeon from 2012 to 2022 were retrospectively reviewed. Demographic, surgical, and implant information was collected. Constructs were stratified by number (three-screw and four-screw) and type (3.5 mm only, 4.5 mm only, and mixed). Incidence rates of HWR and screw breakage were calculated. Three hundred and two hips from 254 patients undergoing PAO were included. Seventy-one hips from 58 patients underwent HWR (23.5%). Eighteen of 259 screws (6.9%) were broken upon removal in 10/71 hips (14.1%). Significantly more 3.5-mm screws were removed (24.7% vs 21.2%;

Adverse mental health status has been linked to less successful surgical outcomes across several orthopaedic subspecialties. Mental health represents a modifiable risk factor that can be optimized preoperatively to maximize outcomes for hip preservation surgery. This study examines the relationship between preoperative mental health status and preoperative and postoperative outcomes for adolescent and adult patients undergoing hip preservation surgery. A prospectively enrolled registry of patients undergoing periacetabular osteotomy or hip arthroscopy at a single institution between 2013 and 2021 was retrospectively reviewed to collect demographics and outcomes before and after surgery. We identified patients self-reporting anxiety/depression or no anxiety/depression preoperatively based on responses to the EuroQol-5D anxiety/depression dimension and compared their preoperative and postoperative Hip disability and Osteoarthritis Outcome Scores (HOOSs) using multivariable linear models and multivariable mixed effects models. Seventy-three patients were included, 40 patients with no anxiety/depression and 33 patients with anxiety/depression. Patients with anxiety/depression had worse preoperative HOOS pain (

Aneurysmal bone cysts (ABCs) in the periacetabular region can be challenging to treat because they create unique problems, given their proximity to articular cartilage and a significant weight bearing surface. This case series details the assessment and treatment of four periacetabular ABCs with a review of pertinent current literature. Treatment approaches used include curettage with 6% phenol chemical adjuvant, type III hemipelvectomy, serial image-guided sclerotherapy injections, and in one case, an exostotic lesion was treated with hip arthroscopy.

Aneurysmal bone cysts (ABCs) in the periacetabular region can be challenging to treat because they create unique problems, given their proximity to articular cartilage and a significant weight bearing surface. This case series details the assessment and treatment of four periacetabular ABCs with a review of pertinent current literature. Treatment approaches used include curettage with 6% phenol chemical adjuvant, type III hemipelvectomy, serial image-guided sclerotherapy injections, and in one case, an exostotic lesion was treated with hip arthroscopy.

The relationship between sagittal lumbopelvic alignment and the bony pathomorphology of hip dysplasia is currently at the forefront of clinical and scientific interest. The aim of this study was to determine whether there is a compensatory lumbopelvic aspect associated with the two major acetabular phenotypes in dysplastic hips.

The concept of femoroacetabular impingement syndrome (FAIS) has received much attention over the past 20 years. Currently, it is believed that FAIS can lead to intra-articular pathologies such as labral tears and articular cartilage lesions, resulting in clinical symptoms and subsequent poor clinical outcomes. FAIS-related articular cartilage lesions are common but unique, and their natural course always leads to early osteoarthritis of the hip. However, despite these cartilage lesions having gradually gained considerable attention, limited consensus has been reached on key aspects, such as diagnosis, mechanisms, classification, and management strategies, which limits clinical and research advances. Hence, an intensive comprehensive overview based on the existing evidence is necessary. The purpose of this review was to introduce the general consensus, controversial issues, and recent advances in FAIS-related articular cartilage lesions.

The primary aim of this study was to quantitatively analysis the acetabular morphological feature and 2D/3D coverage of the Crowe IV DDH hip, dividing into subgroups by the false acetabulum. The secondary aim was to propose a 3D bone mapping to determine acetabular bone defect analysis from the perspective of the implanted simulation.

Total hip arthroplasty is the preferred treatment for advanced hip osteoarthritis, yet complications like hip dislocation (0.2 %-10 %) persist due to factors such as implant design, positioning, surgical technique, and patient-specific conditions. Impingement between prosthetic components or the acetabulum and proximal femur is a primary cause of instability.

Developmental dysplasia of the hip is a prevalent condition in newborns. However, predicting the duration of conservative treatment remains challenging. This study aimed to determine the duration of treatment more precisely by analyzing associated factors. We conducted a retrospective analysis and developed a linear regression model based on 503 patients treated at our institution over the last 10 years. A linear regression model (GLM) was used for predicting treatment duration (df residuals 371, df model 3, Pearson Chi2 78.9, Number of iterations 15). The baseline scenario thereby feature a child with an average age at the beginning of treatment (35th day of life), both sides pathologically affected, and a minimum alpha angle of 29 degrees. The GLM identified age at treatment onset, alpha angle, and bilaterality as significant predictors of treatment duration. A four-week delay in treatment initiation extended the duration by one week, while a 5-degree increase in the alpha angle reduced it by two weeks. Bilaterality added 19 days to treatment duration. However, sex and clinical hip instability did not significantly affect the treatment time. These findings enable the calculation of treatment duration based on identified factors, potentially improving the management and planning of conservative therapies for developmental dysplasia of the hip in newborns.

The growth of periacetabular osteophytes with developmental dysplasia of the hip (DDH) remains unclear. This study aimed to perform a three-dimensional assessment of periacetabular osteophytes and the effects of superiorization (SP) and lateralization (LT) of the femoral head on osteophyte formation. Female (n = 105) with unilateral hip osteoarthritis due to DDH who underwent total hip arthroplasty between 2016 and 2022 were included. The SP and LT of the femoral head were assessed using anteroposterior radiographs. We measured the periacetabular osteophyte using computed tomography. The correlation coefficient between SP or LT and the length of each osteophyte were investigated. Furthermore, multiple regression analyses with SP and LT as explanatory variables and each osteophyte as an objective variable were performed to evaluate the effect of SP and LT on osteophyte formation. The longest osteophyte was the anterior osteophyte (20.48 mm ± 11.8 mm). Acetabular osteophytes correlated with LT as follows: anterior (r = 0.55), posterosuperior (r = 0.51), and inferior (r = 0.48). Multiple regression analysis showed that all acetabular osteophytes were influenced by LT (p < 0.05 for all factors). Hip surgeons may need to be aware that cases with marked lateralization of the femoral head require treatment of the periacetabular osteophytes.

Adolescent hip dysplasia is a condition that often affects hip mechanics, leading to loss of function, pain, and early onset osteoarthritis. Objective literature investigating functional activities remains sparse within this population. A traditional body weight deep squat has translation to everyday tasks, is a clinical screening tool, and is also a common pre/rehabilitation exercise. However, the biomechanical approach and potential movement compensations have not been investigated in this population.

The muscles that encase the hip serve a crucial role in both joint stability and functional efficacy, and as developmental dysplasia of the hip (DDH) progresses, the surrounding musculature may undergo specific adaptations that reduce joint stability, thereby exacerbating dislocation. Yet, the exact nature of changes in muscle morphology and quality remains inadequately investigated. This study aimed to compare magnetic resonance imaging (MRI) evaluations of the iliopsoas and other hip flexor and extensor muscles in children with unilateral DDH before and after treatment.

Hip arthroscopy has gained popularity among orthopaedic procedures over the last decade. The present study aims to evaluate the trends of hip arthroscopy procedures in Italy analysing data recorded by the Italian Ministry of Health, reporting demographics, length of hospitalisation (LOS), diagnosis and the economic impact of the procedure.

Developmental dysplasia of the hip is a common musculoskeletal disorder in newborns and young children, attracting considerable controversy. The purpose of the present study was to analyze the research trends and hotspots over the past three decades in this field.

This study evaluated the results of total hip arthroplasty (THA) via the direct anterior approach (DAA) in the lateral decubitus position combined with acetabular reconstruction via a bulk autograft for patients with developmental dysplasia of the hip (Crowe III and IV).

This study evaluates the necessity of routine X-ray follow-ups in children with developmental dysplasia of the hip (DDH), identified through Graf hip ultrasound, a standard component of screening in Germany. The purpose of this study was to investigate the occurrence of radiological deterioration in hips that were initially diagnosed and treated according to established guidelines within a university-based risk-enriched cohort and to identify associated risk factors.

Hip arthroscopy (HA) procedures have continued to increase worldwide. However, no data are currently available regarding the increasing HA case volume and trends in Turkey.

Little research has investigated the relationship between musculoskeletal pain and body mass index (BMI) in the context of pain-associated psychological distress. This study aims to determine if independent associations exist between BMI, obesity, demographic variables, and psychological distress in patients presenting with hip pain.

Measures such as the Patient Acceptable Symptom State and minimum clinically important difference have been used to contextualize patient-reported outcomes (PROs). Assessment of patients' perception of being "completely better" (CB) after hip arthroscopy has not been studied.

Aneurysmal bone cysts (ABCs) in the periacetabular region can be challenging to treat because they create unique problems, given their proximity to articular cartilage and a significant weight bearing surface. This case series details the assessment and treatment of four periacetabular ABCs with a review of pertinent current literature. Treatment approaches used include curettage with 6% phenol chemical adjuvant, type III hemipelvectomy, serial image-guided sclerotherapy injections, and in one case, an exostotic lesion was treated with hip arthroscopy.

ObjectiveThis study aimed to investigate the relationship between clinical findings and the trabecular microstructure of the subchondral bone in patients with hip osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) using multidetector row computed tomography (MDCT).DesignA total of 63 patients (69 hips) with OA due to DDH were retrospectively reviewed, with 12 healthy controls being included for comparison. Clinical evaluation was performed using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). The trabecular bone microstructure was analyzed using MDCT. Regions of interest in the subchondral trabecular bones of the acetabulum and femoral head were defined in the coronal view, and various trabecular microstructural parameters were evaluated.ResultsBone volume fraction (BV/TV) and trabecular thickness (Tb.Th) exhibited a significant positive correlation with the OA stage, whereas trabecular separation (Tb.Sp) showed a negative correlation. In addition, BV/TV and Tb.Th were negatively correlated with the JHEQ total and pain scores, whereas Tb.Sp was positively correlated with the pain score in all regions.ConclusionsThis is the first study to evaluate the bone microstructure and its relationship with clinical findings in patients with hip OA due to DDH. Our findings suggest that as OA progresses, osteosclerotic changes increase in the acetabulum and femoral head; these changes are associated with worsening clinical symptoms, particularly pain. Targeting the subchondral bone may emerge as a novel treatment strategy for patients with OA due to DDH; nevertheless, further comprehensive studies are required.

(1) To determine the clinical outcomes following revision arthroscopy for patients with hip synovial chondromatosis (SC), and (2) to compare the clinical outcomes between patients undergoing revision hip arthroscopy and primary hip arthroscopy.